Relationship Between Age, Cost, and Patient Reported Outcomes in Primary ACLR:

Abstract

Objectives: To evaluate how surgical trends, costs, and outcomes for anterior cruciate ligament reconstruction (ACLR) vary with patient age. Design: Retrospective Cohort Study Setting: Outpatient Ambulatory Surgery Center Patients: 587 primary ACLR patients from 2009-2016. Inclusion criteria consisted of primary ACLR, complete preoperative and two-year post-operative patient reported outcome (PRO) data. Patients were excluded if they underwent non-operative management, multi-ligamentous repair, or sustained poly-trauma. Intervention: ACLR Main Outcome Measurements: ACLR failure/re-rupture, reoperation, cost of care, Knee Injury & Osteoarthritis Outcome Score (KOOS) and Single Assessment Numeric Evaluation (SANE). Results: Younger patients were prevalently female compared to older patients (p<0.0001). Graft use varied according to age, with older patients more commonly being treated with allograft (p<0.0001). There were equivalent rates of meniscal injuries (p=0.0855), but meniscal treatment differed for patients older than age 25. Older patients on average received more meniscectomies versus repairs (p=0.0009). Operative time was found to be lowest in patients 40 and older. Total implant, day-of-surgery, and two-year episode of care costs were significantly higher for older patients (respectively r=0.48, r=0.43, r=0.37; p<0.001). Re-rupture rates were similar among age groups, however younger patients underwent more reoperations (p=0.0349). While baseline and two-year KOOS and SANE differed across ages (p<0.032), two-year changes did not (p≥0.384). Conclusions: Patient characteristics, treatment techniques, costs, and PROs were found to vary according to patient age but change in PROs did not. These results provide information on how patient age and can influence value in the setting of ACLR. Keywords: Anterior Cruciate Ligament Reconstruction, KOOS, SANE, Cost, TDABC, Value-Based Care Level of Evidence: Level IV